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    Screening for left ventricular hypertrophy in patients with type 2 diabetes mellitus in the community

    Whalley, Gillian; Somaratne, Jithendra B.; Poppe, K.K.; ter Bals, M.M.; Wadams, Gina; Pearl, Ann; Bagg, Warwick; Doughty, Robert N.

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    Somaratne_Cardiovascular Diabetology_2011_10_29.pdf (321.1Kb)
    Date
    2011
    Citation:
    Somaratne, J. B., Whalley, G. A., Poppe, K. K., ter Bals, M. M., Wadams, G., Pearl, A., ... & Doughty, R. N. (2011). Screening for left ventricular hypertrophy in patients with type 2 diabetes mellitus in the community. Cardiovascular diabetology, 10(1), 29.
    Permanent link to Research Bank record:
    https://hdl.handle.net/10652/2132
    Abstract
    Background: Left ventricular hypertrophy (LVH) is a strong predictor of cardiovascular disease and is common among patients with type 2 diabetes. However, no systematic screening for LVH is currently recommended for patients with type 2 diabetes. The purpose of this study was to determine whether NT-proBNP was superior to 12-lead electrocardiography (ECG) for detection of LVH in patients with type 2 diabetes. Methods: Prospective cross-sectional study comparing diagnostic accuracy of ECG and NT-proBNP for the detection of LVH among patients with type 2 diabetes. Inclusion criteria included having been diagnosed for > 5 years and/or on treatment for type 2 diabetes; patients with Stage 3/4 chronic kidney disease and known cardiovascular disease were excluded. ECG LVH was defined as either the Sokolow-Lyon or Cornell voltage criteria. NT-proBNP level was measured using the Roche Diagnostics Elecsys assay. Left ventricular mass was assessed from echocardiography. Receiver operating characteristic curve analysis was carried out and area under the curve (AUC) was calculated. Results: 294 patients with type 2 diabetes were recruited, mean age 58 (SD 11) years, BP 134/81 ± 18/11 mmHg, HbA1c 7.3 ± 1.5%. LVH was present in 164 patients (56%). In a logistic regression model age, gender, BMI and a history of hypertension were important determinants of LVH (p < 0.05). Only 5 patients with LVH were detected by either ECG voltage criteria. The AUC for NT-proBNP in detecting LVH was 0.68. Conclusions: LVH was highly prevalent in asymptomatic patients with type 2 diabetes. ECG was an inadequate test to identify LVH and while NT-proBNP was superior to ECG it remained unsuitable for detecting LVH. Thus, there remains a need for a screening tool to detect LVH in primary care patients with type 2 diabetes to enhance risk stratification and management.
    Keywords:
    Left ventricular hypertrophy NT-proBNP 12-lead electrocardiography type 2 diabetes cardiovascular disease
    ANZSRC Field of Research:
    110201 Cardiology (incl. Cardiovascular Diseases)
    Copyright Holder:
    © 2011 Somaratne et al

    Copyright Notice:
    © 2011 Somaratne et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
    Rights:
    This digital work is protected by copyright. It may be consulted by you, provided you comply with the provisions of the Act and the following conditions of use. These documents or images may be used for research or private study purposes. Whether they can be used for any other purpose depends upon the Copyright Notice above. You will recognise the author's and publishers rights and give due acknowledgement where appropriate.
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